| Psychiatric diagnostic evaluation | CPT 90791 | $97.17 |
| Psychiatric eval with medical services | CPT 90792 | $98.93 |
| Psychotherapy 30 minutes | CPT 90832 | $97.17 |
| Psychotherapy 45 minutes | CPT 90834 | $97.17 |
| Psychotherapy 60 minutes | CPT 90837 | $97.17 |
| ED visit level 1 | CPT 99281 | $65.38 |
| ED visit level 2 | CPT 99282 | $148.02 |
| ED visit level 3 | CPT 99283 | $234 |
| ED visit level 4 | CPT 99284 | $414.45 |
| ED visit level 5 | CPT 99285 | $128.26 |
| Critical care, first hour | CPT 99291 | $724.2 |
| CT head without contrast | CPT 70450 | $739.78 |
| CT head with contrast | CPT 70460 | $781.32 |
| CT head with and without contrast | CPT 70470 | $884.28 |
| CT neck with contrast | CPT 70491 | $1,024.44 |
| MRI brain without contrast | CPT 70551 | $577.47 |
| MRI brain with contrast | CPT 70552 | $847.48 |
| MRI brain with and without contrast | CPT 70553 | $927.12 |
| Chest X-ray single view | CPT 71045 | $73.98 |
| Chest X-ray 2 views | CPT 71046 | $131.16 |
| Chest X-ray 3 views | CPT 71047 | $61.14 |
| CT chest without contrast | CPT 71250 | $829.29 |
| CT chest with contrast | CPT 71260 | $734.57 |
| CT chest with and without contrast | CPT 71270 | $884.28 |
| MRI chest without contrast | CPT 71550 | $373.61 |
| MRI chest with contrast | CPT 71551 | $1,092.61 |
| MRI chest with and without contrast | CPT 71552 | $1,195.28 |
| Lumbosacral spine X-ray | CPT 72100 | $70.68 |
| CT cervical spine without contrast | CPT 72125 | $930.92 |
| CT thoracic spine without contrast | CPT 72128 | $1,080.48 |
| CT lumbar spine without contrast | CPT 72131 | $880.56 |
| MRI cervical spine without contrast | CPT 72141 | $577.47 |
| MRI thoracic spine without contrast | CPT 72146 | $577.47 |
| MRI lumbar spine without contrast | CPT 72148 | $577.47 |
| MRI lumbar spine with and without contrast | CPT 72149 | $847.48 |
| MRI cervical spine with and without contrast | CPT 72156 | $927.12 |
| MRI lumbar spine with contrast | CPT 72158 | $927.12 |
| CT pelvis without contrast | CPT 72192 | $786.66 |
| CT pelvis with contrast | CPT 72193 | $825.9 |
| Shoulder X-ray | CPT 73030 | $53.18 |
| Humerus X-ray | CPT 73060 | $53.18 |
| Hand X-ray 3 views | CPT 73130 | $53.18 |
| MRI upper extremity joint without contrast | CPT 73221 | $781.28 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,254.37 |
| Hip X-ray 2 views | CPT 73510 | $155.41 |
| Knee X-ray 1-2 views | CPT 73560 | $51.49 |
| Ankle X-ray 3 views | CPT 73610 | $49.46 |
| MRI lower extremity joint without contrast | CPT 73721 | $781.28 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,254.37 |
| CT abdomen without contrast | CPT 74150 | $452.79 |
| CT abdomen with contrast | CPT 74160 | $816.47 |
| CT abdomen with and without contrast | CPT 74170 | $1,308.08 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,814.88 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,895.07 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,362.14 |
| MRI abdomen without contrast | CPT 74181 | $781.11 |
| MRI abdomen with and without contrast | CPT 74183 | $1,254.15 |
| Abdominal ultrasound complete | CPT 76700 | $578.15 |
| Abdominal ultrasound limited | CPT 76705 | $486.36 |
| Retroperitoneal ultrasound complete | CPT 76770 | $520.8 |
| Obstetric ultrasound first trimester | CPT 76801 | $118.26 |
| Obstetric ultrasound after first trimester | CPT 76805 | $541.98 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $249.12 |
| Transvaginal ultrasound | CPT 76830 | $373.42 |
| Pelvic ultrasound complete | CPT 76856 | $578.1 |
| Scrotal ultrasound | CPT 76870 | $477.9 |
| Diagnostic mammography unilateral | CPT 77065 | $191.24 |
| Diagnostic mammography bilateral | CPT 77066 | $244.73 |
| Screening mammography bilateral | CPT 77067 | $165.44 |
| EKG complete | CPT 93000 | $38.66 |
| EKG tracing only | CPT 93005 | $31.14 |
| Transthoracic echocardiogram complete | CPT 93306 | $455.82 |
| Transthoracic echocardiogram | CPT 93307 | $876.1 |
| Stress echocardiogram | CPT 93350 | $1,049.5 |
| Hospital discharge, >30 min | CPT 99239 | $145.93 |
| Basic metabolic panel (BMP) | CPT 80048 | $35.61 |
| Electrolyte panel | CPT 80051 | $23.05 |
| Comprehensive metabolic panel | CPT 80053 | $44.1 |
| Lipid panel | CPT 80061 | $43.04 |
| Renal function panel | CPT 80069 | $36.68 |
| Hepatic function panel | CPT 80076 | $35.61 |
| Urinalysis non-automated | CPT 81002 | $5.85 |
| Urinalysis automated | CPT 81003 | $5.83 |
| Glucose quantitative | CPT 82947 | $12.72 |
| Hemoglobin A1c | CPT 83036 | $17.5 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $56.87 |
| Complete blood count with automated differential | CPT 85025 | $26.04 |
| Complete blood count without differential | CPT 85027 | $19.69 |
| Urine culture bacterial | CPT 87086 | $33.01 |
| Urine culture identification | CPT 87088 | $33.98 |
| Tissue exam by pathologist level IV | CPT 88305 | $81.77 |
| Fetal non-stress test | CPT 59025 | $187.21 |
| Office visit, new patient, 15-29 min | CPT 99202 | $66.6 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $74.58 |
| Office visit, new patient, 45-59 min | CPT 99204 | $100.2 |
| Office visit, new patient, 60-74 min | CPT 99205 | $130.8 |
| Office visit, established patient, 5 min | CPT 99211 | $90 |
| Office visit, established patient, 10-19 min | CPT 99212 | $58.2 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $36.06 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $81.6 |
| Office visit, established patient, 40-54 min | CPT 99215 | $93.6 |
| Upper GI endoscopy diagnostic | CPT 43235 | $1,576.27 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,852.97 |
| Sigmoidoscopy diagnostic | CPT 45330 | $476.79 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,233.9 |
| Colonoscopy diagnostic | CPT 45378 | $639.38 |
| Colonoscopy with biopsy | CPT 45380 | $839.72 |
| Colonoscopy with polyp removal | CPT 45385 | $1,825.55 |
| Total shoulder arthroplasty | CPT 23472 | $19,291 |
| Total hip replacement | CPT 27130 | $20,102 |
| Total knee replacement | CPT 27447 | $19,309 |
| Knee revision arthroplasty single component | CPT 27486 | $8,851.76 |
| Knee revision arthroplasty all components | CPT 27487 | $16,574 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $2,884.75 |
| ACL reconstruction | CPT 29888 | $8,633.18 |
| Laparoscopic appendectomy | CPT 44970 | $7,403.73 |
| Laparoscopic cholecystectomy | CPT 47562 | $5,814.96 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $6,562.79 |
| Umbilical hernia repair age 5+ | CPT 49585 | $5,245.59 |
| Lap inguinal hernia repair | CPT 49650 | $5,814.96 |
| Lap incisional hernia repair | CPT 49652 | $5,819.26 |
| Vaginal hysterectomy | CPT 58260 | $5,718.8 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $8,023.14 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $9,447.91 |
| Lap salpingo-oophorectomy | CPT 58661 | $119.93 |
| Complex cataract surgery | CPT 66982 | $2,400.55 |
| Cataract surgery with lens implant | CPT 66984 | $2,400.55 |
| PCI single major coronary artery | CPT 92920 | $4,528.94 |
| PCI with drug-eluting stent | CPT 92928 | $8,885.75 |
| PCI bypass graft | CPT 92937 | $8,885.75 |
| Left heart catheterization | CPT 93452 | $4,966.34 |
| Coronary angiography with cath | CPT 93455 | $4,450.78 |
| Coronary angiography with bypass cath | CPT 93458 | $5,693.29 |
